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Miscellaneous - 31 BANNAN DRIVE 4/30/2018 (2)
AQI�l 31 BANNAN DRIVE ! 3/ 1 - -- f 210/038.0-0116-0000.0 a -- o 53b2NbRT1� .�,,,, Town of North Andover '. HEALTH DEPARTMENT ,SS�CNUSEI CHECK#: / � ��-- ATE: l �/ LOCATION: /r H/O NAME: CONTRACTOR AME: i CN " Type of Permit or License:(Check box) ❑ Animal $ ❑ Body Art Establishment $ ❑ Body Art Practitioner $ ❑ Dumpster $ ❑ Food Service-Type: $ ❑ Funeral Directors $ ❑ Massage Establishment $ ❑ Massage Practice $ ❑ Offal(Septic)Hauler $ ❑ Recreational Camp $ ❑ Sun tanning $ ❑ Swimming Pool $ ❑ Tobacco $ ❑ Trash/Solid Waste Hauler $ ❑ Well Construction $ SEPTIC Systems: ❑ Septic-Soil Testing $ ❑ Septic-Design Approval $ ❑ Septic Disposal Works Construction(DWC) $ ❑ Septic Disposal Works Installers(DWI) $ ❑ Title 5 Inspector $ 0, itle 5 Report $ ❑ Other:(Indicate) $ Health Agent Initials White-Applicant Yellow-Health Pink-Treasurer 4 / CONIlVIONWEALTH OF MASSACHUSETTS G (� EXECUTIVE OFFICE OF ENVIRONMENTAL AFFAIRS � DEPARTMENT OF ENVIRONMENTAL PROTECTION (��-- ,b 1 S/A, TITLE 5 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM FORM PART A CERTIFICATION r Property Address:- Owner's Name: 4kAn Owner's Address: 4kxVvz Date of Inspection: ;a D Name of Inspector- (please print) DrY r,f Company Name: ek- _ \ k1t—� Mailing Address: 66 . -mh, pl%%7 Telephone Number. - CERTIFICATION STATEMENT I certify that I have personally inspected die sewage disposal system at this address and that the information reported below is true.accurate and complete as of the time of the inspection The inspection was performed based on my training and experience in the proper function and maintenance of on site sewage disposal systems. I am a DEP approved system inspector pursuant to ection 15.340 of Title 5(310 CMR 15.000). The system: Passes Conditionally Passes Needs Further Evaluation by the Local Approving Authority- Fails uthorityFails Inspector's Signature: Date: �-20 / The system inspector shall submit a copy of this inspection report to the Approving Authority(Board of Health or DEP)within 30 days of completing this inspection. If the system is a shared system or has a design flow of 10,000 gpd or greater,the inspector and the system owner shall submit the report to the appropriate regional office of the DEP.The original should be sent to the system owner and copies sent to the buyer,if applicable,and the apprm4 ig authority. Notes and Comments Sy,C y� W,�-6 CA Q Z, ****This report only describes conditions at the time of inspection and under the conditions of use at that time.This inspection does not address how the system will perform in the fut or different conditions of use. n .� :� t "7 � ������ ��� �� �t�� �� Page 2 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A ` CERTIFICATION (continued) Property Address: 1 �GhM Owner: Date of Inspection: Inspection Summary: Check A,B,C,D or E/ALWAYS complete all of Section D A. S em Passes: I have not found any information which indicates that any of the failure criteria described in 310 CMR 15.303 or in 310 CMR 15.304 exist Any failure criteria not evaluated are indicated below. Comments: `'Cel`t e B. System Conditionally Passes: One or more system components as described in the"Conditional Pass"section need to be replaced or repaired.The system,upon completion of the replacement or repair,as approved by the Board of Health will pass. Answer_yes,no or not determined(Y,N,ND)in the for the following statements. if"not determined"please explain. The septic tank is metal and over 20 years old*or the septic tank(whether metal or not)is structurally unsound,exhibits substantial infiltration or exfiltration or tank failure is imminent. System will pass inspection if the existing tank is replaced with a complying septic tank as approved by the Board of Health. *A metal septic tank will pass inspection if it is structurally sound,not leaking and if a Certificate of Compliance indicating that the tank is less than 20 years old is available. ND explain.- Observation xplain:Observation of sewage backup or break out or high static water level in the distribution box due to broken or obstructed pipe(s)or due to a broken,settled or uneven distribution box. System will pass inspection if(with approval of Board of Health): broken pipe(s)are replaced obstruction is removed distribution box is leveled or replaced ND explain: The system required pumping more than 4 times a year due to broken or obstructed pipe(s).The system will pass inspection if(with approval of the Board of Health): broken pipe(s)are replaced obstruction is removed ND explain: ve , Page 3 of 11 OFFICIAL INSPECTION FORM- NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION(continued) Property Address: Owner: Date of Inspection: S C. Further Evaluation is Required by the Board of Health: Conditions exist which require further evaluation by the Board of Health in order to determine if the system is failing to protect public health,safety or the environment. 1. System will pass unless Board of Health determines in accordance with 310 CMR 15.303(1)(b)that the system is not functioning in a manner which will protect public health,safety and the environment: _ Cesspool or privy is within 50 feet of a surface water Cesspool or privy is within 50 feet of a bordering vegetated wetland or a salt marsh 2. System will fail unless the Board of Health(and Public Water Supplier,if any)determines that the system is functioning in a manner that protects the public health,safety and environment: _ The system has a septic tank and soil absorption system(SAS)and the SAS is within 100 feet of a surface water supply or tributary to a surface water supply. The system has a septic tank and SAS and the SAS is within a Zone 1 of a public water supply. The system has a septic tank and SAS and the SAS is within 50 feet of a private water supply well. The system has a septic tank and SAS and the SAS is less than 100 feet but 50 feet or more from a private water supply well". Method used to determine distance "This system passes if the well water analysis,performed at a DEP certified laboratory,for coliform bacteria and volatile organic compounds indicates that the well is free from pollution from that facility and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm provided that no other failure criteria are triggered. A copy of the analysis must be attached to this form. 3. Other: Page 4 of 11 - OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION(continued) � Property Address:'I� t\J�1F'aV-seA\ V k Owner: Date of Inspection: njsf \A D. System Failure Criteria applicable to all systems: You must indicate"yes"or"no"to each of the following for all inspections: Yes N Backup of sewage into facility or system component due to overloaded or clogged SAS or cesspool Discharge or ponding of effluent to the surface of the ground or surface waters due to an overloaded or clogged SAS or cesspool Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool Liquid depth in cesspool is less than 6"below invert or available volume is less than'/day flow _ Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s).Number of times pumped Any portion of the SAS,cesspool or privy is below high ground water elevation. _ Any portion of cesspool or priory is within 100 feet of a surface water supply or tributary to a surface water supply. Any portion of a cesspool or privy is within a Zone 1 of a public well. Any portion of a cesspool or privy is within 50 feet of a private water supply well. Any portion of a cesspool or privy is less than 100 feet but greater than 50 feet from a private water supply well with no acceptable water quality analysis. [This system passes if the well water analysis, performed at a DEP certified laboratory,for coliform bacteria and volatile organic compounds indicates that the well is free from pollution from that facility and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm,provided that no other failure criteria are triggered.A copy of the analysis must be attached to this forma (Yes/No)The system fails. I have determined that one or more of the above failure criteria exist as described in 310 CMR 15.303,therefore the system fails.The system owner should contact the Board of Health to determine what will be necessary to correct the failure. E. Large Systems: To be considered a large system the system must serve a facility with a design flow of 10,000 gpd to 15,000 gpd• You must indicate either"yes"or"no"to each of the following: (The following criteria apply to large systems in addition to the criteria above) yes no the system is within 400 feet of a surface drinking water supply the system is within 200 feet of a tributary to a surface dunking water supply _ the system is located in a nitrogen sensitive area(Interim Wellhead Protection Area—IWPA)or a mapped Zone 11 of a public water supply well If you have answered"yes" to any question in Section E the system is considered a significant threat,or answered "yes"in Section D above the large system has failed.The owner or operator of any large system considered a significant threat under Section E or failed under Section D shall upgrade the system in accordance with 310 CMR 15.304.The system owner should contact the appropriate regional office of the Department. Page 5 of Ll ' OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART B CHECKLIST Property Address: ` �i�h ,� t Owner: Date of Inspection: Check if the following have been done.You must indicate"yes"or"no"as to each of the following: Ye No Pumping information was provided by the owner,occupant,or Board of Health Were any of the system components pumped out in the previous two weeks'' Has the system received normal flows in the previous two week period? Have large volumes of water been introduced to the system recently or as part of this inspection Were as built plans of the system obtained and examined?(If they were not available note as N/A) Was the facility or dwelling inspected for signs of sewage back up'-' Was the site inspected for signs of break out Were all system components,excluding the SAS,located on site'? Were the septic tank manholes uncovered,opened,and the interior of the tank inspected for the condition of the baffles or tees,material of construction,dimensions,depth of liquid,depth of sludge and depth of scum? j _ Was the facility owner(and occupants if different from owner)provided with information on the proper maintenance of subsurface sewage disposal systems The size and location of the Soil Absorption System(SAS)on the site has been determined based on: Y no Existing information.For example,a plan at the Board of Health. Determined in the field(if any of the failure criteria related to Part C is at issue approximation of distance is unacceptable) [3 10 CMR 15.302(3)(b)J i Page 6 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION Property Address: Owner: Date of Inspection: FLOW CONDITIONS RESIDENTIAL G� Number of bedrooms(design): / Number of bedrooms(actual): DESIGN flow based on 310 CMR 15.203(for example: 110 gpd x#of bedrooms): ! �� Number of current residents: Does residence have a garbage grinder(yes or no):� Is laundry on a separate sewage system(ye o r no).�Wif yes separate inspection required] Laundry system inspected(yes or no) Seasonal use: (yes or no):_'0 Water meter readings,if available(last 2 years usage(gpd)): 42%,!)CK' �",�'ro Sump pump(yes or no): /VO Last date of occupancy: C :.✓I 77L r COMMERCIAL NDUSTRIAL Iv Type of establishment: Design flow(based on 310 CMR 15.203): 9W Basis of design flow(seats/persons/sgft,etc.): Grease trap present(yes or no):_ Industrial waste holding tank present(yes or no): Non-sanitary waste discharged to the Title 5 system(yes or no): Water meter readings,if available: Last date of occupancy/use: OTHER(describe): GENERAL INFORMATION Pumping Records Source of information: Was system pumped as of the inspection(yes or no): If yes,volume pumped: Ions How was q ty pumped determined? C ' Reason for pumping: Q TYPE OF SYSTEM Septic tank,distribution box,soil absorption system _Single cesspool Overflow cesspool Privy _Shared system(yes or no)(if yes,attach previous inspection records,if any) _hmovative/Alternative technology. Attach a copy of the current operation and maintenance contract(to be obtained from system owner) Tight tank _Attach a copy of the DEP approval Other(describe):�tQ�\L�C �. 1� C!tN`i\�`t1 1"C � C/`` G(•�. �' Approximate f all components,date installed(if known and source of information: Were sewage odors detected when arriving at the site(yes or no): � Page 7 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address:l�. M U t Owner: Date of Inspection: n� BUILDING SEWER(locate on site plan) l ' Depth below grade: Materials of construction:_cast iron _40 PVC_other(explain): Distance from private water supply well or suction line: Comments(on condition of joints,venting,evidence of leakage,etc.): SEPTIC TANK: (locate on site plan) Depth below grade: Material of construction:�ncrete_metal_fiberglass_polyethylene _other(explain) If tank is metal list ager I,age confirmed by a Certificate of Compliance(yes or no): _(attach a copy of certificate) / Dimensions: WX6 Sludge depth: \ i/ Distance from top of�Iydge to bottom of outlet tee or baffle. Scum thickness: fl Distance from top of scum to top of outlet tee or baffle: d f Distance from bottom of scum to bottoam; orb e: How were dimensions determined: Comments(on pumping recommendations,isle baffle d outlet tee or bae condition,structural integrity, liquid levels as related to outlet invert,evidence of lea�g�e tc_): 1�1 GREASE TRAP:_(locate on site plan) V epth below grade:_ Material of construction:_concrete—metal_fiberglass_polyethylene_other (explain): Dimensions: Scum thickness: Distance from top of scum to top of outlet tee or baffle: Distance from bottom of scum to bottom of outlet tee or baffle: Date of last pumping: Comments(on pumping recommendations,inlet and outlet tee or baffle condition,structural integrity,liquid levels as related to outlet invert,evidence of leakage,etc.): Page 8 of 1 I OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: � � � d Owner: Date of Inspection: TIGHT or HOLDING TANK: (tank must be pumped at time of inspection)(locate on site plan) %epth below grade: Material of construction: concrete metal fiberglass_polyethylene other(explain): Dimensions: Capacity: gallons Design Flow: gallons/day Alarm present(yes or no): Alarm level: Alarm in working order(yes or no): Date of last pumping: Comments(condition of alarm and float switches,etc.): DISTRHiUTION BOX: (if present must be opened)(locate on site plan) Depth of liquid level above outlet invert: f( Comments(note if box is level and distribution to outlets equal,any evidence of solids carryover,any evidence of leakage into or out of box,etc.): e- cC .� PUMP CHAMBER: (locate on site plan) Pumps in working order(yes or no): Alarms in working order(yes or no): Comments(note condition of pump chamber,condition of pumps and appurtenances,etc.): • Page 9 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C p�SYSTEM INFORMATION(continued) Property Address: � s -o — � t Owner: Date of Inspection: SOIL,ABSORPTION SYSTEM(SAS):70ocate on site plan,excavation not required) If SAS not located explain why: TI Ching pits,number: leaching chambers,number: leaching galleries,number: leaching trenches,number,length: leaching fields,number,dimensions: overflow cesspool, number: innovative/alternative system Type/name of technology: Comments(note condition of soil, signs of hydraulic failure,level of ponding,damp soil,condition of vegetation, etc.): ` C OW CESSPOOLS: f(cesspool must be um as of i tion)(locate on site plan) pumped I� r��P� Number and configuration:& !�,.� Depth–top of liquid to inle�'invert: Depth of solids layer: V Depth of scum layer: Dimensions of cesspool: w Materials of construction: i Indication of groundwater inflow(yes or no): Comments(note condition of soil,signs f hydraulic failurelevel of nding,condition of vegetation,etc.j: ®PRIVY• (locate on site plan) Materials of construction: Dimensions: Depth of solids: Comments(note condition of soil,signs of hydraulic failure,level of ponding,condition of vegetation,etc.): • Page 10 of_l l OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: Owner: Date of Inspection: SKETCH OF SEWAGE DISPOSAL SYSTEM Provide a sketch of the sewage disposal system including ties to at least two permanent reference landmarks or benchmarks.Locate all wells within 100 feet. Locate where public water supply enters the building. Pc Q • ° a _D b®x(r-)- LAI fit • Page 11 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: (IMS►a �1\' Owner: Date of Inspection: SITE EXAM Slope lo"H3 tw yv d Surface water NOME, Check cellar Ce((Rf ! ZY Shallow wells No Nt Estimated depth to ground water feet Please indicate(check)all methods used to determine the high ground water elevation: gbtained from system design plans on record-If checked,date of design plan reviewed: Observed site(abutting property/observation hole within 150 feet of SAS) Checked with local Board of Health-explain: Checked with local excavators,installers-(attach documentation) Accessed USGS database-explain: . You must describe how you established the high and water elevation: e.s i '1 h Ab Ir w'vNo Q ft ,rKf-J_ til Gb - T10 WK 5 '5 a � F I V F Septic Inspection Date: Time: -evih ACACI( PROPERTY OWNER: huh ��r AtorA /1h 'v�do 3( � ADDRESS: On the above date and time, I made a visual inspection of the septic system at the above-referenced property. Based upon my visual inspection, I.certify that the septic was in proper working order as of the date and time of the inspection. This certification does not constitute a guarantee nor warrant and because of the age and unpredictable characteristics of the septic system, it is not to be interpreted as insuring that the system will continue to be in working order for any future period of time, no matter how brief. Owner further agrees to indemnify and hold harmless inspecting company from any liability and costs incurred from the result of any third party reliance upon information provided. Acknowledge by: Raymond N. epore DEE RAY, Inc. 588 Woburn Street Wilmington, MA 01887 J �� �6 mS•^�. 'r"�' �...� y x�r�1s.��N� �r x =� �` F� ����5r-� yam' ��""r, ,t�. °�' £ r v x "i ti. � Y �% "w `r,:s- S.5 $ �k Y xr.F r�s �CJw%n#2 { j * MS Ell m-@r'ie�3,,, -I� „y •. .f i "'''3�;'fi�t .�•/t,� Y M.-� - Al«g vF�a�RT'�Yt"�"r f„ iM��}� � P::{�,4e-�.�. � .{, :+fie ,�� �{�L.,i , �S T`t,�AplC dew<d'. ^���: �.' ��� ��z7 "�'��.°''';+-•�+,�r'�'��uy y �',,. �.� '..'st,.a�,/ ;F,-.�' � �%,�„�� .a� y�z,a�'. r s35:.'` .a+���q „�4y '�:,, •r i i �97 k' a. dx t '•q, ""y'.ro' �.- +!d"`.,' a '.••'=s ty- itl,*_ a 9 [ .,»y. �, j1 ys`' ar. xr'� ., (�p•. l/ '?:..,--,,e ,. 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Locations of two ew dry wells for field Location of a new dry well for washing machine f t Location No. 1 Date �ORTM TOWN OF NORTH ANDOVER Certificate of Occupancy $ sACNUSEBuilding/Frame Permit Fee $ Foundation Permit Fee $ Other Permit Fee $ TOTAL $ �d -c- ,# � 1 6 i 6 V Building Inspector TOWN OF NORTH ANDOVER BUILDING DEPARTMENT APPLICATION TO CONSTRUCT REPAI RENOVAT OR DEMOLISH A ONE OR TWO FAMILY DWELLING 1-M-11 Ytcs'a a ��zaai��,' .� sew;: i�y�: m M BUILDING PERMIT NUMBER: DATE ISSUED: `b? Q�� ic SIGNATURE: Building Commissioner for of Buildings Date Z SECTION 1-SITE INFORMATION O 1.1 Property Address: 1.2 Assessors Map and Parcel Number: ,3E3 1 ( � 3 ? Map Number B Parcel Number 1.3 Zoning Information: I C 1.4 Property Dimensions: Zoning District Proposed Use Lot Areas Frontage ft 1.6 BUILDING SETBACKS ft Front Yard Side Yard Rear Yard Required Provide Required Provided Re red Provided 1.7 Water Supply M.G.L.C.40. 54) 1.5. Flood Zone Information: 1.8 Sewerage Disposal System: Public ❑ private 0 Zone Outside Flood Zone ❑ Municipal ❑ On Site Disposal System ❑ SECTION 2-PROPERTY OWNERSIUVAUTHORIZEDAGENT Historic District: Yes No M 2.1 Owner of Record OAM,4-L) .i ?Is,,/JI .3/ /✓o 9A)DO✓ R- Name(Print) Address for Service ignature Telephone 2.2 O er of Record: / ove- .l J /���tl/ % d Ce/Y!/Yl C�'1 SCh.• �/0 � � iL ��j� j Name nt _ Address for Service: G�PPc� i nature Telephone SECTION 3-CONSTRUCTION SERVICES 90 3.1 Licensed Construction Supervisor Not Applicable ❑ griceL .. Licensed Construction Supervi or: License Number mn Address / i 1714' �� ic 73 Explratto Date Sig Telephone r 3.2 Registered Home Improvement Contractor Not Applicable ❑ r4wl_ �v&hto- Company ame 1 r�lfo� M ress Z / 5�Y.P, 56-- / n� . Registration umber r Add (i IW G63 Lb Yt Expira n Da SiipdtuV Tele2lidne V SECTION 4-WORKERS COMPENSATION(M.G.L C 152 § 25c(6) Workers Compensation Insurance affidavit must be completed and submitted with this application. Failure to provide this affidavit will result in the denial of the issuance of the building it. Signed affidavit Attached Yes.......0 No.......0 SECTION 5 Description of Proposed Work check an a ticable New Construction ❑ Existing Building IK Repair(s) Alterations(s) Addition ❑ Accessory Bldg. ❑ Demolition Rf Other ❑ Specify Brief Description of Proposed Work: ICEP�/K 14_/ZYC 16-17,14/91 SECTION 6-ESTIMATED CONSTRUCTION COSTS Ite /� DECEstimated Cost(Dollar)to be (F)FICIAL USE i(}) y EAR Eapplicant A �&N K Com leted b emut a licant 1. Building (a) Building Permit Fee Multiplier 2 Electrical (b) Estimated Total Cost of Construction 3 Plumbing Building Permit fee tel X (b) �© 4 Mechanical HVAC 5 Fire Protection Q 6 Total 1+2+3+4+5 Sa Q Check Number SECTION 7a OWNER AUTHORIZATION TO BE COMPLETED WHEN OWNERS AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT as Owner/Authorized Agent of subject property Hereby authorize to act on My behalf,in all matters r ative to work autho d by this building permit application. ^ �/ 7��az7� Signature of Owner Date �a — SECTION 7b OWNER/AUTHORIZED AGENT DECLARATION 1, Pl sg/✓l as Owner/Authorized Agent of subject property i Hereby declare that the statements and information on the foregoing application are true and accurate,to the best of my knowledge and belief A01)A/ L/ J . iso A l Print N 4. �-- ' iature of Owner/A ent Date I Main- NO. OF STORIES SIZE BASEMENT OR SLAB SIZE OF FLOOR TINMERS OT 2ND 3RD SPAN DIMENSIONS OF SILLS DEI ffiNSIONS OF POSTS DR ENSIONS OF GIRDERS HEIGHT OF FOUNDATION THICKNESS SIZE OF FOOTING X MATERIAL OF CHIMNEY IS BUILDING ON SOLID OR FILLED LAND IS BUILDING CONNECTED TO NATURAL GAS LINE :r FORM U - LOT RELEASE FORM 1 INSTRUCTIONS: This form is used to verify that all necessary approvals/permits from Boards and Departments having jurisdiction have been obtained. This does not relieve the applicant and/or landowner from compliance with any applicable or requirements, ************A-****************APPLICANT FILLS OUT THIS SECTION****** * * * -/ a APPLICANT �GWQ ZCVk tom HONE978 6So�-93�� LOCATION: Assessor's Map Number c3 PARCEL_ SUBDIVISION LOT(S) ;� STREET > A N 4J 0 .J F� - �ST. NUMBER_ OFFICIAL USE RE #PMMENDATIONS OF TOWN AGENTS: Ake- ONSERVATION ADMI STAATOR DATE APPROVED DATE REJECTED COMMENTS ,SQ e- A41aAa k4e w b&e'�A (204&a„t TOWN PLANNER DATE APPROVED DATE REJECTED COMMENTS FOOD INSPECTOR-HEALTH DATE APPROVED DATE REJECTED SEPTIC INSPECTOR-HEALTH DATE APPROVED. �' O DATE REJECTED COMMENTS ,i z)fi ( (-. � � ,v N� _ .. anl�lJr� PUBLIC WORKS-SEWER/WATER CONNECTIONS DRIVEWAY PERMIT FIRE DEPARTMENT RECEIVED BY BUILDING INSPECTOR DATE Revised 9W jm Town of North Andover Building Department The following is a list of the required forms to be filled out for the appropriate permit to be obtained. FOR ROOFING, SIDING, INTERIOR REHABILITATION PERMITS 1) BUILDING PERMIT APPLICATION 2) DEBRI REMOVAL FORM 3) WORKERS COMP AFFIDAVIT 4) PHOTO COPY OF H.I.C. AND/OR C.S.L. LICENSES 5) COPY OF CONTRACT 6) FLOOR PLAN OF PROPOSED INTERIOR WORK f FOR ADDITIONS /DECKS 1)BUILDING PERMIT APPLICATION 2) FORM U 3) MORTGAGE PLOT PLAN (MINIMUM) 4) DEBRI REMOVAL FORM 5) WORKERS COMP AFFIDAVIT 6) PHOTO COPY OF H.I.C. AND C.S.L. LICENSES 7) COPY OF CONTRACT 8) FLOOR/CROSSSECTION/ELEVATION PLAN OF PROPOSED WORK WITH SPRINKLER PLAN AND HYDRAULIC CALCULATIONS (if applicable) 9) MASCHECK ENERGY COMPLIANCE REPORT (if applicable) FOR NEW CONSTRUCTION (SINGLE AND TWO FAMILY) 1) BUILDING PERMIT APPLICATION 2) FORM U 3) GROWTH MANAGEMENT BYLAW 4) CERTIFIED PROPOSED PLOT PLAN 5) PHOTO COPY OF H.I.C. AND C.S.L. LICENSES 4 6) WORKERS COMP AFFIDAVIT 7) TWO SETS OF BUILDING PLANS (one to be returned) TO INCLUDE SPRINKLER PLAN AND HYDRAULIC CALCULATIONS (if applicable) 8) COPY OF CONTRACT(if applicable) it 9)MASCHECK ENERGY COMPLIANCE REPORT In all cases if a variance or special permit was required the Town Clerks office must stamp the decision from the board of appeals that the appeal period is over. The applicant must then get this recorded at the Registry of Deeds. One copy and proof of recording must be submitted with application. CARTER & TOWERS ENGINEERING CORP. surveys, (foundanj Repo�t� JOSEPH D. CARTER, P E. & R.L.S. 6 FAIRVIEW AVENUE SWAMPSCOTT, MASS. 0)907 Ts I. 594.0366 i i �� 106.81 A- _ 9$ 7-3 j>v4 LL ^�G yilk G o o _. LOT V) 2 j Z s , ' ®the Salem 5� Savings Bank and Lawyers Title Ins . Co. I hereby certify that i have ermined NORTH ANDOVER, MASS. the premises and all easements, SCALE: 1" _ 4 0 ' encroachments and buildings are August 11 , 1975 located on the ground as shown. 0 further certify that the buildings shown conformed to the zoning laws of North Apdoserwhen constructed. �N Of h4� I further certify that this property o�� JOSEPH " is not located in the X °AVID v ITER rn established flood hazard area. . "` 991, 0 sua�� Joseph D. Carter R.L.S. #9387 N NORTH ANDOVER BUILDING DEPARTMENT Tel: 978-688-9545 DEBRIS DISPOSAL FORM In accordance with the provision of MGL c 40 S 54, a condition of Building Permit Number is that the debris resulting from this work shall be disposed of in properly licensed solid waste.disposal facility as defined by MGL Chapter 111, S 150 A. The debris will be disposed of in: (Location of Facility) I Signature Pe Applicant Date e NOTE: Demolition permit from the Town of North Andover must be obtained for this project through the Office of the Building Inspector ♦ s F• BORT}{ OFtta.eo rbgq. Town of North Andover « = Building Department 27 Charles Street ��SSAC"usEt�y North Andover MA 01845 Tel: 978-688-9545 HOMEOWNER LICENSE EXEMPTION Please print. DATE e '_'? UJ JOB LOCATION 3 I�N'D d 1EI; r9 Number Street Address n/ Section of Town "HOMEOWNER 3� / 7d' ?e2 —�3d Number / Home Phone Work Phone PRESENT MAILING ADDRESS /y) 4I Al t)j E1te City Town State Zip Code The current exemption for"Homeowners"was extended to include owner-occupied dwellings of six units or less and to allow such homeowners to engage an individual for hire who does not possess a license, provided that the owner acts as supervisor. (State Building Code Section 109.1.1) DEFINITION OF HOMEWOWNER: Person(s)who owns a parcel of land on which he/she resides or intends to reside, on which there is, or is intended to be,a one to six family dwelling,attached or detached structures ac- cessory to such use and and/or farm structures. A person who constructs more than one home in a two-year period shall not be considered a homeowner. Such"homeowner"shall submit to the Building Official, a form acceptable to the Building Official,that he/she shall be responsible for all such work performed under the building permit. (Section 109.1.1) The undersigned"homeowner"assumes responsibility for compliance with the State Building Code and other Applicable codes, by-laws, rules and regulations, The undersigned"homeowner"certifies that he/she understands the Town of No.Andover Building Department minimum inspection procedures and requirements and that he/she will comply with said procedures and require nts.01 F HOMEOWNERS SIGNATURE D_WQI- �C,O APPROVAL OF BUILDING OFFICIAL Note:Three family dwelling 35,000 cubic feet, or larger,will be required to comply with State Building Code Section 127.0 Construction Control. Town of North Andover .y R4 Office of the Conservation Department _ ip Community Development and Services Division 9e • � 27 Charles Street SS�+cmu Alison McKa North Andover,Massachusetts 01845 Telephone (978)688-95_ Y Conservation Associate Fax(978)688-9542 September 10, 2003 Ronald Pisani 31 Bannon Drive North Andover, MA 01845 RE: Proposed Rear Deck Replacement at the property of 31 Bannon Drive Dear Mr. Pisani: On 9/5/03 Julie Parrino, Conservation Administrator, and myself performed a site inspection at your property for the proposed replacement of a rear deck as described in the submitted building permit. Upon this inspection, it was observed that an isolated wetland resource area exists within 100-feet of the proposed work. It was also observed that the old deck had already been torn down and two new sonotubes were added for the replacement deck. The woman with whom we spoke with during the inspection explained that the new deck would have the same footprint as the previously existing deck. She indicated that no expansion was proposed. Yard debris and grass clippings were also noticed within the wetland resource area and/or within the 25-foot no-disturbance area, which is prohibited. Under the Massachusetts Wetlands Protection Act (MGL c. 131 s.40) and the North Andover Wetland Bylaw(C. 178 of the Code of North Andover), any activity within 100-feet of a wetland or other applicable resource area(defined under Section 178.2 of the Bylaw and under Section I(C) of the Regulations) requires a permit from Conservation. This department has determined that the replacement of the deck would have minimal, if any impacts to the wetland resource area. Therefore, the Conservation Department will authorize the deck replacement within the previous footprint only without a conservation permit filing. Please be aware that any proposed work different from what is proposed or any future work within 100 feet of this isolated resource area would be subject to a Conservation filing. The following conditions shall be implemented and followed in lieu of a Conservation permit filing: • Prior to Conservation's sign off on the building permit, all yard debris and grass clippings must be removed from the resource area and within the 25' no-disturbance area. • Prior to Conservation's sign off on the building permit, the applicant shall permanently mark the edge of the"25' No-Disturbance Zone"with signs or markers spaced evenly every 25 feet incorporating the following text: "Protected Wetland Resource Area" (available at the Conservation Office for $2.00 each). This will designate their sensitive and assure no further l� sensitivity BOARD OF APPEALS 688-9541 BUILDING 688-9545 CONSERVATION 688-9530 HEALTH 688-9540 PLANNING 688-9535 inadvertent encroachment into the wetland and are subject to review and approval by the Conservation Department. • Buffer zone plantings shall be planted along the 25' no-disturbance, or in close proximity to this area if existing limits are being maintained beyond this point, to further deter encroachment into the resource area. • The applicant shall arrange an on site meeting with Conservation staff to discuss the location of the plantings, the specific number of plantings, and type of plantings. These plantings shall be planted prior to the end of the growing season(no later than October 15th 2003). • The Conservation Department shall be notified for an on site post-construction meeting to ensure that the deck was constructed as proposed and that the plantings were planted as advised. Your anticipated cooperation is appreciated. Please feel free to contact me if you have further questions or concerns in this regard. Sincerely, Alison E. McKay Conservation Associa- Cc: NA CC File Building File G i NORTH o" Of E over No. (0 _ . z q_,g -aoo 3 dover Mass. ��p A°oz? ATED P'?�\,tt� H BOARD OF HEALTH PERMIT T D Food/Kitchen Septic System di BUILDING INSPECTOR THIS CERTIFIES THAT . 0 Pi.3..0.. Found ........ ............'�.�.�:................... ......................................................�......... anon 3 A has permission to erect...R ti. ... buildings on ON ...V..... Rough .... ................. ........................................................ to be occupied as.... ...... ......�......S..1.Z. ......REAR....�.C..x Chimney ..... . .. .... ..... . ...... .... ... . ...... ........... .... ...... provided that the person accepting this permit shall in every respect conform to the terms of the application on file in Final this office, and to the provisions of the Codes and By-La s relating to the In pection, Alteration and Construction of Buildings in the Town of North Andover. 38711 ` id) m PLUMBING INSPECTOR VIOLATION of the Zoning or Building Regulations Voids this Permit. Rough PERMIT EXPIRES IN 6 MONTHS Fina' UNLESS CONSTRUCTIONS ART ELECTRICAL INSPECTOR Rough W...............................................�A........................................ Service BUILDING INSPECTOR Final Occupancy Permit Required- to Occupy Building GAS INSPECTOR Rough Display in a Conspicuous Place on the Premises — Do Not Remove Final No Lathing or Dry Wall To Be Done FIRE DEPARTMENT Until Inspected and Approved by the Building Inspector. Burner Street No. SEE REVERSE SIDE smoke Det. Location 2/ -� ., No.' �l Date NORTH TOWN OF NORTH ANDOVER Op Certificate of Occupancy $ Building/Frame Permit Fee $ Foundation Permit Fee $ sACHUSE r Other Permit Fee $ Sewer Connection Fee $ Water Connection Fee $ TOTAL $ L � Building Inspector 1 3359 $ an Vara Div. Public Works F'ERN(IT NO. APPLICAT..ION FOR PERMIT TO BUILD****** *NORTH ANDOVER, MA NIAPNO.v/ d3. I.OFNO.' (j �!� 2. RECORDOFO\\'NERSII1P DATE [TOOK PAGE ZONE: SUB DIV. LOT NO. LOCA"TION G' ✓L-� / PURPOSE OF BIIILDINC / O\PNER'SNAME NO.OF STORIES SIZE OWNER'S ADDRESS ti BASEMENT OR SLAB ARCIIITECTS NAME SIZE OF FLOOR TINIBERS 1 1 2ND 3RD BUILDER'S NAME � SPAN DISTANCE TO NEAREST BUlaING DINIENSIONSOFSILLS DISTANCE FROM STREET DIMENSIONS OF POSTS DISTANCE FROM LOT LINES-SIDES REAR DIMENSIONS OF GIRDERS :AREA OF 1.01' FRONTAGE II EIGHT OF FOUNDATION THICKNESS IS BUILDING NEW SIZE OF FOOTING x IS BUILDING ADDITION MATERIAL OF CIIININEY IS BUILDING ALTERATION LS BUILDING ON SOLID OR FILLED LAND WILL BUILDING CONFORM TO REQUIREMENTS OF CODE IS BUILDING CONNECTED TO TORN WATER- BOARD OF APPEALS ACTION, IF ANY IS BUILDING CONNECTED TO TORN SEWER IS BUILDING CONNECTED TO NATURAL GAS LINE 1NSTUCTIONS 3. PROPERTY INFORNIATiON LAND COST EST. BLDG.COST PAGE I F1LL.OUT SECTIONS 1-3 EST.BLDG.COST PER SQ. FT. EST. BLDG.COST PER ROOM ELECTRIC METERS MUST BE ON OUTSIDE OF BUILDING SEPTIC PERMIT NO. AT1"ACIIED GARAGES NIUSTCONFORNI TO STATE FIRE REGULATIONS 4. APPROVED BY: PLANS MAST BE FILED AND APPROVED BY BUILDING INSPECTOR BUILDING INSPECTOR DATE FILED OWNERS TEL# Pz CONTR.TEL# FE _ GGGc- SICNA1URkOF—OWN C CONTRLIC# O 2-Cs �D ar- /A C^� FEE II.I.C.# / y 3 3 J PERMITGRANTED ? 19 Revised 5/5/99 JN'1 ' t4O R TFt Town of ®Vel No. 4117 - - _- co Co,:H,Q dover, Mass. ORATED �S. 15 G BOARD OF HEALTH Food/Kitchen PERMIT Septic System row BUILDING IN THIS CERTIFIES THAT........ . ............ .. ... ...... ... ........................................................................... Foundation 44 -0 has permission to erec ............6......*..... buildings on ..3/.......... .... ................. .......... /.�/..4........ Rough to be occupied as.... ........................ �.. Chimney provided that the person accept! his permit shall in every ect conform to the terms of the application on file in Final this office, and to the provisions f the Codes and By-Laws r ating to the Inspection, Alteration and Construction of Buildings in the Town of North Andover. PLUMBING INSPECTOR VIOLATION of the Zoning or Building Regulations Voids this Permit. Rough PERMIT EXPIRES IN 6 MONTHS Final UNLESS CONSTRUCTIO ��j ELECTRICAL INSPECTOR .�" ` Rough ................................................................................................................. Service BUILDING INSPECTOR Final _ Occupancy Permit Required to Occupy Building GAS INSPECTOR Display in a Conspicuous Place on the Premises — Do Not Remove F nagh No Lathing or Dry Wall To Be Done . FIRE DEPARTMENT Until Inspected and Approved by the Building Inspector. Burner Street No. SEE REVERSE SIDE smoke Det. My MOM— -1 In.Yys{nion, arm w "Mom IS a mom" Kil �T t >;_L ww.- 71 it 14 pr a RR A.W t ' 7P. DEPARTMAS Pueuc Sum % N CONSTRUCTIONS E%-TIONI%SUPERVISOR LICEN� Hp) u In Ago pq aN ab �--1! .Ex fires:'- Birthdate: rr 1U qt Thy 1-ji -k VNY4 AQ EWE Res Ql�l IsKo"F;�E � I R jp a=j T. 0oi; A N ANDOV�R NA @184� j Nfl",,V A no tv�t ....... I KIM 9A0PU w—w-W v 11 stool jjx Wrl !,ado*jQ'It'.41 P;Jj �45nvwwdy My i�Ir' _jI MAUL 1,0 1h I S '0S r 1:HISIM 1, r 4 ]l lip VA OIO .: DTJidxI L 011 SOHO131 ;q_ 7 7-- Pow Ohio Ax r. ply, ,j k': oot, _yJ Wa 00 Jaws ANSI all z p I J